Ask most people what neurosurgeons do and they’ll tell you they operate on the brain. But these medical specialists are also trained to help patients suffering from back and neck pain as well as a host of other illnesses ranging from carpal tunnel syndrome to epilepsy and Parkinson’s disease.

People are most surprised to learn that neurosurgeons are back specialists. In fact, more than 80 percent of the nation’s 3,800 Board certified neurosurgeons specialize in treating back and neck problems. A neurological surgeon may provide either surgical or non-surgical care, depending on the nature of the injury or illness.

What Kinds of Illnesses do Neurological Surgeons Treat?    Neurosurgery is the surgical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spine, brain, nervous system and peripheral nerves. It encompasses adult and pediatric patients with disorders of the brain and skull, and their blood supply, including the vertebral and carotid arteries; disorders of the pituitary glands; disorders of the spinal cord and vertebral column; and disorders of the cranial and spinal nerves. Some of the specific disorders neurosurgeons treat include:

• aneurysms
• cervical spine disorders
• chronic pain
• herniated disk
• hydrocephalus
• lumbar spinal stenosis
• pituitary tumors
• sciatica
• stroke (Brain Attack)
• thoracic spine disorders
• tumors of the brain and spinal cord

What is the Role of the Neurosurgeon?   Neurosurgeons provide the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care and rehabilitation) of neurological disorders. Because neurosurgeons have extensive training in the diagnosis of all neurological disease, emergency room doctors, neurologist, internists, family practitioners, and osteopaths often call upon them for consultations.

How are Neurosurgeons Trained?  Neurosurgery has one of the longest training periods of any medical specialties due to the extreme complexity of the nervous system and the advanced techniques used in neurosurgical operations. After four years of medical school, followed by a one-year internship program (devoted to acquiring knowledge in fundamental clinical skills), the doctor enters a neurosurgical residency program of five to seven years. While in the program, neurosurgical residents are trained in all aspects of neurosurgery, including the cerebrovascular system, the spine and spinal cord, trauma, tumors, pain management and pediatric surgery. Each resident must complete a minimum of 60 months of training in neurological sciences.

At least 36 months must be devoted to clinical neurosurgery in a neurosurgical-training program or programs accredited by the American Council of Graduate Medical Education. A minimum of three months should be devoted to clinical neurology. Some neurosurgeons opt to do an additional fellowship in a particular area of study after their residency.

Board Certification  Following residency in a training program approved by the Accreditation Council of Graduate Medical Education, the neurological surgeon may see certification in the practice of neurosurgery through the American Board of Neurological Surgery (ABNS). This credential signals a special level of commitment to, and expertise in, the neurosurgical specialty. Certification by the Board is based upon approval of an applicant’s educational and training qualifications, a review of the physician’s professional practice – including opinions of his or her colleagues, and the passage of written and oral examination.

The certification process includes a thorough assessment of the neurosurgeon’s skill, judgment and depth of knowledge. During their training program, candidates sit for a comprehensive written primary examination sponsored by the ABNS. Following training, the neurosurgeon submits a list to the ABNS of patients for whom he or she was the responsible physician during a period of at least 12 consecutive months. The candidate must also submit three professional references. Candidates for certification must be scheduled for oral examination within five years of completing training or passing the primary examination, whichever is later.

Finally, the candidate sits for a three-hour oral examination that covers the diagnosis and management of surgical and medical diseases of the nervous system. Upon successful completion of these steps, the neurosurgeon becomes Board certified in the practice of neurological surgery. All Active members of the American Association of Neurological Surgeons must be Board certified.

Tools and Techniques   Over the past two decades, neurosurgery has been transformed into a very "high tech" specialty. Most significant, however, have been innovations in medical equipment that have given neurosurgeons the ability to provide patients with safer, more effective treatments.

Beginning in the early 1960s, neurosurgeons began working with one operative tool that literally revolutionized the practice of neurosurgery. That tool is the operating microscope. For the first time, surgeons were able to see the finest detail with tremendous clarity and focus – they were able to see aneurysms in the brain that needed to be clipped, ruptured disks in the spine to be removed, or brain and spinal tumors that had to be removed without trauma to the surrounding tissue.

Another high tech development in the practice of neurosurgery was the advent of stereotactic radiosurgery which involves the precise delivery of a high concentrated dose of radiation for the purpose of stopping a growth, eliminating an abnormality or relieving symptoms caused by the abnormality. Stereotactic radiosurgery is used to treat brain tumors, abnormal blood vessels in the brain, hearing loss or facial pain. It is not surgery in the conventional sense, as it does not require an operation in which an incision is made.

This treatment may be performed using one of two complex pieces of equipment – one called linear accelerator, the other a Gamma Knife, depending upon the nature of the disorder. The linear accelerator delivers focused converging beams of radiation to the target by means of x-rays. The Gamma Knife (which is not a knife, but a large machine) delivers low-intensity gamma rays to the target.

These breakthrough technology applications have helped to make neurosurgery safer for patients and ensure better outcomes than ever before.

(Permission of this article was granted by the American Association of Neurological Surgeons.)